Tarlov Cyst

What is Tarlov Cyst?

Perineural (or Tarlov) cysts are cerebrospinal fluid-filled nerve root cysts most commonly found at the sacral level of the spine, although they can be found in any section of the spine, which can cause progressively painful radiculopathy.

Community Statistics

Perineural (or Tarlov) cysts are cerebrospinal fluid-filled nerve root cysts most commonly found at the sacral level of the spine, although they can be found in any section of the spine, which can cause progressively painful radiculopathy.

Although the cause(s) of Tarlov cysts formation is yet scientifically unproven,there are a number of conditions that can create increased spinal fluid pressure, increasing the flow of cerebrospinal fluid into the cysts and causing them to expand in size and create symptoms. The cysts are then termed symptomatic Tarlov Cysts. Some incidents or conditions that might potentially cause the asymptomatic cysts to become symptomatic are;
* Trauma to the spinal cord such as falls, automobile accidents and heavy lifting.
* Childbirth, and epidurals.
* An increase in the CSF pressure.
* A blockage of the CSF can result in cyst formation.
* It is also noted that the herpes simplex virus can cause the Tarlov cyst symptoms to worsen during a herpes virus outbreak.

Symptoms of expanding/enlarging cysts occur due to compression of nerve roots that exit from the sacral area. Symptoms may include the following, dependent on the location of the cysts and the section of the spine they occur:
Pain in lower back (particularly below the waist) and in buttocks, legs, and feet
Pain in the chest, upper back, neck, arms and hands
Weakness and/or cramping in legs and feet / arms and hands
Parasthesias (abnormal sensations) in legs and feet or arms and hands, dependent on cyst locations
Pain sitting or standing for even short periods of time
Pain when sneezing or coughing
Inability to empty the bladder or in extreme cases to urinate at all
Bowel or bladder changes, including incontinence
Swelling over the sacral (or cervical, thoracic, or lumbar) area of the spine
Soreness, a feeling of pressure and tenderness over the sacrum and coccyx (tailbone), extending across the hip and into the thigh with cysts in the sacrum. Same feelings in upper sections of the spine dependent on cyst locations
Headaches (due to the changes in the CSF pressure) and sometimes accompanied by blurred vision, pressure behind the eyes and optic nerve pressure causing papilledema (optic nerve swelling)
Dizziness and feeling of loss of balance or equilibrium
The feeling of sitting on a rock
Pulling and burning sensation in coccyx (tailbone) area, especially when bending
Sciatica
Vaginal, rectal, pelvic and/or abdominal pain
The sciatic nerve is the longest nerve in the body and it originates at the S2, S3 level of the spinal column. It crosses the buttocks and extends down the leg into the foot. Sciatica is a syndrome that results in burning, tingling, numbness, stinging, electrical shock sensations in the lower back, buttocks, thigh, and pain down the leg and foot. Severe sciatica may also result in weakness of the leg and foot.
Some TCs don't cause symptoms and are not diagnosed. However, when symptoms develop that are suggestive of TCs, MRI will demonstrate their presence, and Myelogram or CT may demonstrate the CSF flow between the spinal subarachnoid area and the cyst, determining how rapidly the cyst is filling and whether or not the fluid is freely flowing in and/or out of the cyst.

Name

Description

Tarlov Cyst

Perineural (or Tarlov) cysts are cerebrospinal fluid-filled nerve root cysts most commonly found at the sacral level of the spine, although they can be found in any section of the spine, which can cause progressively painful radiculopathy. The annual incidence of perineural cysts is estimated at approximately 5%, although large cysts that cause symptoms are relatively rare with annual incidence estimated at less than 1/2,000. Women are affected more frequently than men. Patients with perineural cysts present with pain in the area of the nerves affected by the cyst, muscle weakness, difficulty sitting for prolonged periods, loss of sensation, loss of reflexes, pain when sneezing or coughing, swelling over the sacral area, parasthesias, headaches, sciatica, and bowel, bladder and sexual dysfunction. The cysts typically occur along the posterior nerve roots and can be valved or nonvalved. The main feature that distinguishes perineural cysts from other spinal lesions is the presence of spinal nerve root fibres within the cyst wall or in the cyst cavity. The majority of perineural cysts are sporadic. However, in some cases cysts have been observed among relatives, suggesting the possibility of a familiar trait with autosomal transmission. There are a number of conditions that can cause the cysts to become symptomatic, including traumatic injury, heavy lifting, childbirth, epidurals, and trauma to the spinal cord. It has also been observed that the herpes simplex virus can cause the body chemistry to change and that perineural cyst symptoms worsen during herpes virus outbreaks. Diagnosis is based on magnetic resonance imaging (MRI), computed topography (CT) or myelogram of patients experiencing lower back pain or sciatica. The main differential diagnoses are meningeal diverticula and long arachnoid prolongations, which can be distinguished by rapid filling on myelography compared to the delayed filling of perineural cysts. Differential diagnoses also include herniated lumbar discs, arachnoiditis and, in females, gynecological conditions. Treatment involves lumbar drainage of the cerebrospinal fluid, CT scanning-guided cyst aspiration, decompressive laminectomy, cyst and/or nerve root excision and microsurgical cyst fenestration and imbrications. However, surgical treatment for perineural cysts is complicated by postoperative pseudomeningocoele and intracranial hypotension, and recurrence of the cyst. Pain therapy may offer a nonsurgical alternative for the treatment of symptomatic perineural cysts. Those who have progressive and prolonged symptoms may experience neurological damage if the cysts continue to compress nerve structures.
(Copied from Orphanet.org)

Most Tarlov cysts are discovered on MRI, CT or Myelogram. It is sometimes confusing to make an accurate diagnosis as to the cause of the symptoms, if there are multiple diagnoses found, such as herniated discs, ruptured disc, DDD (degenerative disc disease). It is sometimes diagnostically conclusive that the cysts are the cause of symptoms, when pain is improved by aspirating the fluid from the cysts. Although using a needle to aspirate CSF from the cysts can temporarily relieve symptoms, eventually the cysts will refill and the symptoms will recur usually within hours.

Some patients report that changes in their diet and/or the addition of nutritional supplements to alter acid-base balance (alkalinity/acidity) in the body may have helped with symptoms; however, there have been no scientific studies in Tarlov cyst patients to prove any benefit with dietary changes or dietary supplements.
Pain medications plus medications used to treat chronic nerve related pain (such as antiseizure medications and antidepressants) may be helpful in some patients. NSAIDs (non-steroidal anti-inflammatory drugs) are an important adjunct to the treatment to help with nerve inflammation and irritation.
Lidoderm patches used for post herpetic neuralgia (PHN) may be applied locally over the sacral area to provide some temporary relief of discomfort sitting and assistance with pain management. In Europe, this same product is marketed under the name Neurodol.
When pain is intractable, despite a variety of interventions, or when other neurological symptoms become severe (ie bowel and bladder dysfunction, severe paraesthesias,etc.), and the sacrum is eroding and remodeling, surgery may be the treatment of choice.
There are a small number of physician's in the world who have surgical expertise in the treatment for TCs, and the short-term and long-term outcome of surgery is improving but variable in individual patients at this time.
The usual surgical procedure consists of fenestration and imbrication of the cysts and then packing all the dead space around the cysts with fat, glue, and/or muscle. The body does not like dead spaces, and new cysts will possibly develop in the dead spaces around the old cysts, if not filled.
Due to the potential risks for further nerve damage or spinal fluid leaks, there might be increased symptoms postoperatively, including more bowel and bladder problems, when the cysts are located in the S2-S3 nerve location. However, the neurosurgeons are perfecting surgical techniques and including intra-operative nerve monitoring to decrease the risks of further nerve damage.
Due to the long term nerve compression causing irritation and inflammation to the nerves, it may take months to a year to determine the full benefit of the surgery.
Steroid injections may provide some short term pain relief.
Pain may be also temporarily controlled by aspiration of the cysts and then injecting the cysts with fibrin glue (a substance produced from blood chemicals involved in the clotting mechanism). The aspiration of CSF and injection of fibrin glue procedure theoretically is designed to remove the CSF from the cyst, and to block the entrance or the neck of the cyst with the sealant glue, to prevent return of the flow of CSF into the cyst. Some patients have found immediate relief after the procedure, while others have reported a delayed benefit from the procedure when the nerve irritation has subsided. After the procedure, there are outcomes of both short term relief, as well as longer term relief reported.
Transcutaneous Electrical Nerve Stimulation (TENS) has been proven useful for some in pain management. TENS devices deliver electrical impulses through the skin to the cutaneous (surface) and afferent(deep) nerves to control pain. Unlike medications and topical ointments, TENS does not have any known side effects, other than skin

Those who have progressive and prolonged symptoms run a risk of neurological damage, if the cysts continue to compress nerve structures.
If the nerve damage is progressive and affects bladder and bowel function and other body systems, it is important to have a good primary physician to coordinate referrals to specialists.
Many patients become disabled and unable to continue to work, due to the pain and multi-systems affected issues.
Individuals who undergo neurosurgery or those who have the cysts aspirated and injected with fibrin glue have varied results from no improvement to moderate improvement, but in some cases have worsened symptoms and more nerve damage from the procedures. There are also some patients who are much improved, evidenced by an increase in activities without the severity of symptoms recurring, and the need for less medications.There is no scientific analysis to date of all the compiled reports from the various procedures. The Foundation is working with the physicians and the researcher to provide collaboration, communication and an improved database of results of treatments.
Collaboration of those very few members of the medical community who are willing to treat Tarlov cysts, as well as improved continuing medical education (CME) is essential to improve the short and long term prognosis of those diagnosed with Tarlov cysts.

Yes, unfortunately I've been to many many doctors of several different specialties. PLEASE don't let them do any injections into your spine. Also please research Adhesive Arachnoiditis because many if not all patients that have TC have Arachnoiditis. The cysts by nature press the nerves to the edge causing clumping.

Dr. Frank Fagenbaum has a website you can check out and then you can contact his office. He will do a phone consultant and you will send your records to him. He is in Dallas, Texas. My pain management would not cooperate and do the block. He even offered to speak to them. Many doctors do not have a great deal of knowledge about Tarlovs. Dr. F. Is one of few that do. Reach out to him.
You can also contact the Tarlovs Cysts Disease Foundation and they can provide information as well. Unfortunately, I even had one doctor tell me that he would refuse to listen to anything they said because why does a cyst need a foundation. You have to be your own advocate. Remember before doctors we're reducated on MS they thought it was all in people's heads. The Tarlovs Foundation is partnering with Harvard for at least one study.

@Lynnsha,I was diagnosed 7 months back.. still managing pain through PT. I did freak out for first two months - so I guess its normal. I've been following the thread here and also hoping to avoid surgery. Many of them here seem to go couple of yrs before the symptom gets worse..I dont know if the cyst stays the same or grows over a period of time. Also, what cause the growth of these cysts? My pain is localized to legs so far. How about you?

Doctors
Remember that you must become your own advocate. Research and know what nerves effect what regions of the body. If you have Tarlovs on the sacrum know what nerves could be affected. You may have to educate the doctors. If they dismiss you, let them go and don't try to prove anything. Find a new one. Remember that they are your consultant and if they don't offer insight then keep looking. If they are not open minded, you don't want them as your doctor. Chances are you will be their only Tarlov patient unless they are a neurosurgeon.
Family and Friends
They may not be capable of understanding you. They will notice you have changed, but remember before you had this issue you probably had no need to really understand either. Be patient with others and understand that it is like a new culture for you. Some friends will move on and others will still be nice, but won't make much effort . Some fear what they do not understand and this can be easier for them to deal with by ignoring the need for change. Remember that while you cannot go hiking with them or shop all day or even sit on the hard seats at a baseball field with no back or neck support that your spirit is still the same and you are still as precious. This journey just means you will need to adjust. They do not likely relate to constantly assessing your environment for the most comfortable seat. They may also not understand your new found frustration over having to repeat things because of a lack of endurance or even that your house is messy or you left something on the floor because you could not bend over one more time. You will be seen differently so know who you are and look for validation in yourself. Learn to make your complaints more generic. I don't feel well is sufficient and leave the details off if you can. Hearing those details make most people uncomfortable. Keep a diary where you can put those thoughts and feelings that others don't want to hear. Otherwise you could appear as a Debbie downer. Spend some time with pets. They help the brain release endorphines and help relieve stress. Taking care of someone else is good for you. Forgive others for moving on after all, your paths are different. Be patient with your significant other. You are different to them now in some cases like a whole new person. They have to learn to adjust too. Learn about their style of communication and be complementary to that. Reassure them with appreciation. Don't criticize for things like how they fold the laundry, etc. Don't try to control the environment as this is a sign you need some introspection. Focus on controlling how you react. If you cannot do your old hobbies then find new ones. You are responsible for your own happiness and joy. Know the difference. Happiness comes from how you react to external environment and is externally driven. Joy is self generated from your spirit. It creates an equilibrium and state of gratitude.
If you want to talk, please do. Here is where you can share details freely.

I am glad that your pain specialist is willing to try the block. Mine would not do it. They probably read that any puncture to the spine could cause more of them and are afraid to risk making a mistake. Dr. F even offered to talk to them, but they were unwilling. There is still so much to learn about these and patients often have to become the expert. Remember that most of the doctors practicing today we're taught either nothing about them or taught that they do not cause symptoms. As long as your doctor is careful your spine should be fine and maybe you will notice a difference. It is something you will have to decide. How are you doing now? Any updates?

Hello.
My husband was recently diagnosed with Tarlov Cysts. For almost 2 years we didn't and couldn't get answers to our questions until we finally did. You need to go to Tarlov Cyst Disease Foundation and also here and you could see how serious this issue is.There are only 2 surgeons in the country that specialize in Tarlov Cysts and one is in CA and one is in TX. Please, I hope you read this and will look into this more.
Good luck and God Bless

Hi all,
I flew to see Dr. F from Florida since I have 2 Tarlov cysts and pain that is consistent with them. One of them is 1 CM long and about to go on disability given the pain. I hate to give up my work.
In the absence of anything else wrong and with a sucky quality of life, I figured it was a no brainer.
He suggested I get a block at S-2 and see if i get pain relief and that would suggest this is my problem. My pain doctor suggested that it could still be the problem even if the block doesn't relieve the pain.
What has been the experience of this group and why would i need to have the block. Has this been the group's experience?

Hello there I was just wondering if there is another option besides surgery to take care of the cyst. I am a mother of two young boys and there is no way I would be avle to have the surgery and be laid up in bed recovering. I dont want to miss my childrens lives. I also would like to know what other patients are taking for the pain.

If you are referring to Dr. Frank Feigenbaum then yes, I have heard of many positive outcomes from surgery with this Neurosurgeon.
But you must remember, each individual is different and surgical results may differ from patient to patient due to age, additional medical conditions, or current cyst damage.

New Resource

This Foundation is dedicated to the mission of finding the best possible solutions that will resolve the life-altering problems caused by symptomatic Tarlov cysts (perineural cysts,sacral nerve root cysts).

The Tarlov Cyst Disease Foundation is an advocate for patients and promotes research and education about Tarlov cysts. The website provides information about symptomatic Tarlov cysts, which may cause such symptoms as sciatica, difficulty sitting or standing for more than short periods of time, coccyx (tailbone) pain, pain in buttocks and legs, leg cramps, paresthesias (strange sensations in legs and feet), bladder and bowel dysfunction,chronic pelvic, abdominal, and genitalia pain.

If the cysts are located higher in the cervical,thoracic, or lumbar sections of the spine, the symptoms can cause pain and paresthesias in the neck, shoulders,chest, arms, legs, and lower back.

If you, or a member of your family, friend or a patient has been diagnosed with Tarlov cyst(s), we believe that you will gain beneficial information and hope from your visit to this site.

We also hope that you will share with us, what you have already learned, in order to benefit the research and education the Foundation is providing. The composite of our shared information leads to improved communication, understanding and proof that you are not alone in the struggle to find assistance and support. Our combined efforts will provide present and future benefits. Research and education are the keys!

The Foundation's achievement of specific purposes and objectives will provide hopeful solutions for the future. We will work tirelessly to bridge the gap of missing knowledge until that mission is accomplished.

Sincerely,

Tarlov Cyst Disease Foundation Board of Directors

03/20/2017

Orphanet

Orphanet is the reference portal for information on rare diseases and orphan drugs, for all audiences. Orphanet’s aim is to help improve the diagnosis, care and treatment of patients with rare diseases.

Orphanet services

Orphanet offers a range of freely accessible services:

An inventory of rare diseases and a classification of diseases elaborated using existing published expert classifications.

An encyclopaedia of rare diseases in English and French, progressively translated into the other languages of the website.

An inventory of orphan drugs at all stages of development.

A directory of expert resources, providing information on expert clinics, medical laboratories, ongoing research projects, clinical trials, registries, networks, technological platforms and patient organisations, in the field of rare diseases, in each of the countries in Orphanet’s consortium.

An assistance-to-diagnosis tool allowing users to search by signs and symptoms.

An encyclopaedia of recommendations and guidelines for emergency medical care and anaesthesia.

A fortnightly newsletter, OrphaNews, which gives an overview of scientific and political current affairs in the field of rare diseases and orphan drugs, in English and French.

A collection of thematic reports, the Orphanet Reports Series, focusing on overarching themes, directly downloadable from the website.

The organisation and governance of Orphanet

Orphanet is led by a consortium of around 40 countries, coordinated by the French INSERM team. National teams are responsible for the collection of information on expert centres, medical laboratories, ongoing research and patient organisations in their country. All Orphanet teams work according to the Orphanet Standard Operating Procedures.

The French coordinating team is responsible for the infrastructure of Orphanet, management tools, quality control, rare disease inventory, classifications and production of the encyclopaedia.

Orphanet is governed by various committees, which independently supervise the project in order to ensure its coherence, evolution and viability.

At European level

The Management Board is composed of Orphanet country coordinators. This committee is chaired by the director of the Inserm-Orphanet department. This board identifies funding opportunities and guides the project.

The Steering Committee is composed of representatives from the agencies and bodies which finance Orphanet’s core services. This committee is chaired by the director of the Inserm-Orphanet department. This committee ensures that Orphanet’s content reflects the policy, strategy or plan at the country level in the field of rare diseases.

The International Advisory Board is composed of experts proposed by the Management Board and nominated by the Steering committee. Board members are in charge of advising the Steering committee regarding the overall strategy of the project.

At national level

The National Advisory Board is composed by members nominated by the appropriate legitimate institutions which are defined at country level. The board members contribute with their expertise to Orphanet at country level.

03/20/2017

Canadian Tarlov Cyst Disease Support

Canadian Living is a Blog written and maintained by a Canadian Tarlov Cyst Disease Patient Advocate.

The Blog Contains Tarlov Cyst Specific Information, Patient Testimonials, Patient Stories, an extensive list of Tarlov Cyst Information and Patient Support Links, and other information directed at a Canadian audience, living within Canadian Healthcare and Legal Systems.

03/20/2017

AIMIS Spine, Nicosia, Cyprus

AIMIS Spine - American Institute of Minimally Invasive Spine Surgery

US & International surgeons beyond borders

AIMIS Spine is able to offer Tarlov Cyst Disease Surgical Treatment to International Patients through the expert and experience offered by Dr. Frank Feigenbaum.

All MRI's and Patient Information is forwarded to Dr. Feigenbaum who will offer you a free, telephone consult based on the MRI and the medical history information you provide.

For more information on the AIMIS Spine, Tarlov Cyst Treatment Program please contact AIMIS Spine directly.

03/20/2017

Tarlov Cyst Survival - Patient Support Group

Tarlov Cyst Survival is a Yahoo group created by a Tarlov Cyst Disease Patient with over ten years of Tarlov Cyst Patient Advocacy experience.

This is a Yahoo Patient Support Group with an extensive International Membership. Hundreds of Tarlov Cyst Disease Patients have worked hard to develop a collection of medical research and experience based information offered to support and educate Tarlov Cyst Disease Patients.

Membership is made up of other Tarlov Cyst Disease Patients who support, encourage, share and educate each other providing new patients with the opportunity to learn, understand and advance their own situations.

The group offers compassion and respect with minimal moderation allowing for honesty and respect for each patients right to individual beliefs and behaviours.

"Please treat others how you wish to be treated".

Many patients have developed lifelong friendships with others who truly understand.

This is a closed group providing privacy and security to members.

Application and Introduction required.

03/20/2017

Clinical Trials

CoRDS, or the Coordination of Rare Diseases at Sanford, is based at Sanford Research in Sioux Falls, South Dakota. It provides researchers with a centralized, international patient registry for all rare diseases. This program allows patients and researchers to connect as easily as possible to help advance treatments and cures for rare diseases. The CoRDS team works with patient advocacy groups, individuals and researchers to help in the advancement of research in over 7,000 rare diseases. The registry is free for patients to enroll and researchers to access.

Enrolling is easy.

Complete the screening form.

Review the informed consent.

Answer the permission and data sharing questions.

After these steps, the enrollment process is complete. All other questions are voluntary. However, these questions are important to patients and their families to create awareness as well as to researchers to study rare diseases. This is why we ask our participants to update their information annually or anytime changes to their information occur.

Researchers can contact CoRDS to determine if the registry contains participants with the rare disease they are researching. If the researcher determines there is a sufficient number of participants or data on the rare disease of interest within the registry, the researcher can apply for access. Upon approval from the CoRDS Scientific Advisory Board, CoRDS staff will reach out to participants on behalf of the researcher. It is then up to the participant to determine if they would like to join the study.

Our Resources

Our Community Leaders

Community leaders are active users that have been touched by the rare disease that they are a part of. Not only are they there to help facilitate conversations and provide new information that is relevant for the group, but they are there for you and to let you know you have a support system on Rareshare.